Where can we publish?

BMJ 2004; 329 doi: (Published 29 July 2004) Cite this as: BMJ 2004;329:299
  1. Samer Jabbour, assistant professor (sjabbour{at}
  1. Faculty of Health Sciences, American University of Beirut

    Imagine you are facing the following situations. You want to say something in a respected publication about a conflict between the health ministry and private hospitals over reimbursement. You wish to discuss matters that touch local sensitivities, such as mismanagement of health programmes, but you expect blame for showing “dirty laundry” internationally. You publish commentaries about local issues in “high impact” journals but discover that only a few of your local colleagues have read them. You have researched a locally relevant topic that may not interest overseas readers and hope to publish the results locally. What are the appropriate platforms for publishing each of these types of article? You might think that local or regional journals will fulfil the need, but this would be wishful thinking today in many developing countries.

    Why can't we upgrade our journals?

    Let's take representative examples from my region: the Lebanese Medical Journal (LMJ) and the Eastern Mediterranean Health Journal(EMHJ), which is equivalent to a regional public health journal,may seem to fit the purpose. The LMJ reaches most registereddoctors, health professionals, public health and academic institutions,and many healthcare facilities across Lebanon. Numerous healthinstitutions in the region receive the EMHJ. Unfortunately,both journals suffer chronic problems that undermine their usefulness.One is irregular publication: the LMJ has just published itsJanuary-March 2003 issue, while the EMHJ's latest issue datesto 2002. With such a backlog any sense of timeliness is lost—andmuch of the relevance with it. Another problem of these journalsis their content. Research and subject reviews dominate, andserious debates and critical reflections on important issuesare rare. We desperately need strong local and regional journals,but only international journals get our articles read as wewould like. What we actually manage to get published in internationaljournals and its impact locally is a fascinating subject forfuture reflection.

    Who is responsible for the health of our local journals? Public bodies overseeing the journals have the prime responsibility. The LMJ and the EMHJ are backed by powerful, resourceful institutions:the Lebanese Order of Physicians and the World Health Organization'sEastern Mediterranean Regional Office. The current situationis inexcusable, whatever the reasons, and I wonder where thepublication of good journals fits in the list of priorities.

    Our ministries of health and higher education should support journal publication to stimulate research and promote debate, but don't. Universities pressure their staff—through criteria for promotion—to publish in international rather thanlocal journals. Thus local recognition comes from internationalexposure rather than appreciation of grounding in local work.Nevertheless, international journals do give a platform forthe voices of developing countries. Weak local journals underminethese voices, while European and North American (this is practicallywhat “international” means) journals are strengthened throughattracting diverse material and thus readership, sustainingthe imbalance.

    The health of journals everywhere is an international responsibility. Funders of research, who understandably prefer acknowledgment in international journals, contribute to the imbalance between international and regional journals. The problems of local journals cannot be solved through greater access to journals producedin rich countries. International agencies working with regionaland country partners can help to promote local journals. Ultimately,we can't expect change without push from us—local researchersand practitioners. Doctors bear a special responsibility becausethey continue to dominate the health sector, produce much ofthe local health research, and have prestige and access to resources. Many local people have rich international expertise in publishing, editing, and reviewing. Why can't we upgrade our journals? Is it the insurmountable institutional factors? Is it because of a lack of vision that we can't see how underdevelopment in health publishing is reproduced or how to change it?

    Even when the interests of all stakeholders meet, we may still fail to sustain good journals. We have excellent researchersto make strong editorial boards, but they can't do the job alone. Equally important are competent and accountable management, production, and marketing teams, to address chronic problemsin institutional memory and functioning.

    Suppose we manage to produce local or regional journals regularly. What would they be about? Would they lead the way, as the BMJ does, by muddying themselves in the dirty waters of social and political realities of health? Or would they confine themselves to the safe terrain of clean research, as more typical international journals do? Most health journals in our region seem to prefer the second approach, leaving little space for critical reflection on health matters as public issues. This should be corrected. Journals are public goods, and so we must have collective oversight and must take on the shared responsibilities of keeping them healthy.